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Virginia Tech Letterhead - Reynolds Homestead

Virginia Tech Letterhead - Reynolds Homestead

Virginia Tech Letterhead - Reynolds

Reynolds HomesteadSummer Scientists Nature CampRegistration and Permission FormsAges 10-13$65.00 per studentReynolds Homestead Continuing Education Center463 Homestead LaneCritz, Virginia 24082276/694-7181 Fax: 276/694-7183www.reynoldshomestead.vt.eduThis form must be completed and returned to the Reynolds Homestead by July 1.No camper will be allowed to participate without this form on file.Camp Dates: Monday – Friday, July 8-12, 2013, 9:00 a.m. to 3:00 p.m. each day. Campersshould dress appropriately for the weather each day. No flip-flops! Bring a bag lunch.Snacks will be provided.Camper Information (Please Print):Camper’s Name ________________________________________________________________Gender: ______ Age: _____ DOB: ____________________ Grade completed as of 6/1: _____Address: _____________________________________________________________________Parent/Guardian’s Name: _________________________________________________________Home Phone: _____________________________ Work Phone: __________________________Cell Phone: _______________________________ E-mail: ______________________________Emergency Contacts:1) Name & Relationship: _____________________________________________________Work or Home Phone: ______________________________Cell: ___________________2) Name & Relationship: _____________________________________________________Work or Home Phone: ______________________________Cell: ___________________Code of Behavior:Participant safety is a high priority and these rules are meant to ensure that all participants have aSAFE as well as enjoyable experience. 1) Be kind to all living things (plants, animals, bugs, andpeople too!). 2) Follow all instructions of the teacher and assistants. 3) Respect the property of theReynolds Homestead. Failure to comply with the above rules could result in suspension from camp.The Reynolds Homestead reserves the right to remove a camper from the program if rules arebroken or if a camper’s behavior creates an unsafe situation. When you sign this form, you areagreeing to the Code of Behavior and have discussed it with your child.Invent the FutureV I R G I N I A P O L Y T E C H N I C I N S T I T U T E A N D S T A T E U N I V E R S I T YA n e q u a l o p p o r t u n i t y , a f f i r m a t i v e a c t i o n i n s t i t u t i o n

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